Does prolonged OSA contibute to Dementias ?

[dsm]

Below is an extract from the below link started by James Skinner(the whole article is a great read). James original thread is here
viewtopic/t39737/Deadly-Sleep.html

I have long believed the below to be the ereason my own mother succumbed to Dementia.
Have said so several times, then James found this report.

.....................

Alzheimer’s Disease and other Dementias


Is it possible that Obstructive Sleep Apnea (OSA) causes Alzheimer's Disease
(AD) or the other dementias? I believe so. As a retired clinical neurologist and
former OSA patient, I have a special interest in sleep disorders medicine, especially
in how it affects the brain and the rest of the nervous system. I am thoroughly con-
vinced of the connection between OSA and AD and will remain so until credible
studies prove otherwise. The brain is incapable of withstanding over three million
apneas extending over a fifty year period without suffering dire consequence. Check
the numbers: a man in his early 20’s has an AHI of 27. That’s 27x 8hours or 216
obstructions per night or 78,840 per year or 3,942,000 by the time he reaches his
70’s assuming he makes it to that age…I did make it. (That’s my scenario I did the
numbers on). Of course, in the real world the number of obstructions are subject to
considerable variation, in some cases, even worse. The point is that the number of
obstructions that any individual may experience during a lifetime are grossly under-
estimated and take their toll in ways we have failed to recognize.


Numerous short term studies have been done on cognition (mental processes) and
sleep or the lack thereof, but there are few or no long term studies to
determine OSA's relationship to Alzheimer’s Disease (AD) and/or the other major
dementias (ie. Vascular ~ 30%, fronto-temporal ~ 5%, Lewy body disease ~ 5%).


At 50-60%, Alzheimer's, is the most common form of all the dementias
affecting an estimated 5.2 million Americans. According to the American Academy of
Neurology, 10% of people older than age 65 and nearly 50% of people older than 85
suffer from AD. A 2003 study from the Archives of Neurology estimates that there will
be 13.2 million Americans with Alzheimer's by the year 2050 if no effective prevention
or cure is found.

I’ve asked experts the question: “Does OSA cause Alzheimer’s Disease?”
And “No, there is no evidence,” is the usual reply. There is no evidence because
there are no studies directly addressing the issue. Why are there no studies to prove
or disprove this question? I cannot answer that, but I suspect there are many
reasons, not the least of which is the fragmentation of health specialties into their
separate niches with a narrow focus that excludes disorders in the periphery of their
specialized fields. The disorder may get lost in the shuffle so to speak. The lack
of financial support is always a big issue. Then, there is reluctance to accept
new ideas in direct conflict with long held beliefs.


Could it be that if OSA proves to be a cause of AD, that drugs would no longer
be needed? It is almost certain that drugs currently being used would no longer be
necessary. The best case scenario is that AD would rapidly disappear and become
a disease of the past. The PAP machine business would certainly do well until
something better comes along.


Many polysomnograms (PSGs) or in lab sleep tests have been done on
patients with AD revealing an incidence of OSA of up to seventy to ninety percent.
The assumption has been that AD causes OSA, or they just happened to coincide,
but it is my contention that OSA is the cause of AD.


Studies have not yet conclusively proven my hypothesis that long-standing
undiagnosed OSA is a cause of AD (and/or one or more of the other dementias), but
evidence is accumulating. For example, OSA is a known risk for Type 2 Diabetes.
In the April 2008 issue of The Archives of Neurology, type 2 Diabetics had an in-
creased risk or developing Mild Cognitive Impairment (MCI)(2) which is the earliest
stage of dementia. The majority of patients with MCI progress to AD at rate of about
twelve percent per year.


Additionally, OSA is a known risk for the development of high blood pressure.
Like patients with Type 2 diabetes, those with high blood pressure were also found
to have an increased risk of developing MCI.(3) Since the majority of patients with
MCI eventually progress to Alzheimer’s Disease at a rate of approximately twelve
percent per year, then it’s not a stretch to conclude that OSA is a cause of
Alzheimer’s Disease. And what about the individual who has both high blood
pressure and Type 2 Diabetes; is risk even greater?


In 2006 a study in the Proceedings of the National Academy of Sciences
showed low brain oxygen (hypoxia) raises Alzheimer’s risk in the mouse brain with a
genetic susceptibility.(4) A group of mice with an Alzheimer's gene were given a
maze test in which they all performed normally. They were separated into two
groups, one exposed to 16 hours of a reduced oxygen environment (hypoxia) daily for
several weeks; the other group in a normal environment.



The maze test was repeated and revealed the hypoxic mice performed poorly,
whereas the control groups performance remained normal as before. All the mice
were sacrificed and their brains examined under the microscope. Plaques and
neurofibrillary tangles typical of Alzheimer's Disease were present in the hypoxic
mouse brain specimens, whereas the controls were normal. According to
investigators, "Hypoxia treatment markedly increased Aβ deposition and neuritic
plaque formation and potentiated the memory deficit in Swedish mutant APP
transgenic mice. Taken together, our results clearly demonstrate that hypoxia can
facilitate AD pathogenesis, and they provide a molecular mechanism linking
vascular factors to AD. Our study suggests that interventions to improve cerebral
perfusion may benefit AD patients." The study suggests that preventing brain hypoxia
(as occurs in OSA) may reduce the risk of developing Alzheimer’s Disease.


Reported in the June 27th issue of Neuroscience Letters, sleep apnea
patients have shrunken brain structures called “mammillary bodies” involved i
memory according to Rajesh Kumar, PhD and colleagues from the University of
California at Los Angles (UCLA). High resolution MRI brain scans revealed
mammillary bodies to be twenty percent smaller in patients with sleep apnea than in
normals. “These findings are important because patients suffering from memory
loss from other symptoms, such as alcoholism or Alzheimer’s Disease, also show
shrunken mammillary bodies,” Dr. Kumar said in a press release.


A recent study form San Diego showed that Sleep Disordered Breathing, in-
cluding OSA, is and important risk factor for cognitive impairment in older women.(5)


A study from Stanford University School of Medicine in 2001 found a signifycant
portion of sleep disordered breathing (mostly OSA) is associated with ApoE
epsilon4 in the general population.(14) The ApoE epsilon4 gene is a well-known risk
factor for Alzheimer's Disease and cardiovascular disease.


Neuroimaging studies have been performed on patients with OSA including
CT, MRI. PET and SPECT scans, revealing a variety of defects, but none has dis-
played anything quiet as dramatic as in a study published in SLEEP July7, 2008, by
Dr. Paul M. Macey et al. (1) The report reveals results of a new MRI technology called
DTI (Diffusion Tensor Imaging). It is an extremely sensitive method for determining
damaged nerve fibers (axons). This new imaging technique reveals multiple areas
of brain damage in OSA patients not known to exist until now. DTI revealed various
sized color-coded yellow-orange patches of brain damage scattered throughout the
brains of a group of forty-one men and women subjects with OSA. Their ages
ranged from thirty-eight to fifty two years old and they had not yet been treated. The
areas of nerve fiber injury were wide spread, located in critical regions of brain in-
cluding prefrontal, temporal and parietal lobes. The cerebellum and brainstem were
equally involved. This is the first report of DTI imaging of a middle aged group with
OSA to my knowledge. The findings have far reaching implications.


One can anticipate finding even more areas of damage in an older population
as studies are done. What problems result from each one of these areas of brain
damage? Is it possible that they are responsible for difficulties with cognition, mood,
behavior, memory, heart regulation, high blood pressure, breathing control, fear,
anxiety and other emotional disorders including depression? Could these brain
damaged areas accumulate enough to cause a multitude of disorders and ultimately
result in Alzheimer’s Disease and/or the other dementias?


The structural changes likely represent accumulated damage over sustained
periods of time. Are they permanent or do they improve or disappear with treatment?
No one knows yet, but my guess is they may improve to some degree or even re-
solve with treatment, but we will have to wait and see.


The implications of these findings are profound. Early treatment of OSA could
potentially prevent the development of Alzheimer’s Disease. Now is the time to wake
up the public and our snoozing medical community and put an end to this disease.

(End of this extract)

[Jason S.]

From my experience I say YES, it does. My dad will turn 90 next month. I know its great that he's lived so long, but the last 5 years he's suffered from dementia (not Alzheimers).

Spending much time in hotel rooms with him, he was always a very loud snorer, a snorter, waking himself up, i.e. the classic OSA symptoms, but in his era he never sought a doctor's advice so it went untreated. I think quite possibly this has led to "mini strokes" which have increased his dementia to the point now where he can't form a sentence or comprehend more than a few words. Sad, because physically he's still strong. I've lost my dad, even though he' still walking around.

[SuperGeeky]

Denial is a nice warm blanket, not a river in Egypt The neurological problems keeps popping up it's ugly head.

Last night I had AHI of 10. The apneas were clustered together with Avg Daily time in Apnea, over 11 minutes. Brain damage, nah!

Everyone in my immediate family is Mensa, genius IQ and above. Highest, my oldest brother at 180 IQ. My profession used to be an Actuary. I left over ten years ago because it was too exhaustive.

I took a Neuropsychological Exam some three years ago, before knowing I had SA. The IQ was very low. I was told I would have to try very very hard to pursue anything of interest.

My hat is off to anyone out there who has held their job during this ordeal. Personally, I am not the same person I once was. My world has become smaller. Harder to remember short term. It's like looking backward while riding in a boat, no wake.

I'm entertaining the thought of doing 'Memory' exercises to see if I can build it up again.

Oh, how Science can literally take years to prove what is plainly obvious....


Take care,

SG

[plr66]

DSM, thanks for this thread. My own cognitive functioning has been so markedly affected in the past 2 years that I was driven to my PCP to help me figure out whether I had Alzheimers in my 50's, or whether I was dying or something. No dramatics here. I never go to a doctor for anything. But I really knew this was incredibly life-changing for me. And I was right.

So then the diagnosed OSA in August last year, and I have pursued my diligent (obsessive) commitment to my therapy since that time. My cognitive functioning still suffers, though I am not nearly as "drunk & brain-dead-feeling" in the mornings as I was before cpap. But I do still suffer from serious memory problems and just stupid scatter-brained behavior which is truly embarrassing and destructive of professional self esteem.

I posted a thread before yours about a teleconference on this subject that I do plan to tune in to, on 3/17/09. The link is: http://www.westsideent.stirsite.com/tel ... ignup.html if anyone is interested. (I am not endorsing this, just mentioning it for general information). I would think that this would be a concern for an awful lot of our posters here. I wish I knew whether I need to be treating the sx of possible early Alzheimers, now that I have been treating the OSA and still have the possible sx of AD.

[Debjax]

Everyone in my immediate family is Mensa, genius IQ and above. Highest, my oldest brother at 180 IQ. My profession used to be an Actuary. I left over ten years ago because it was too exhaustive.
SG

No doubt OSA had alot to do with it. Same here, I know I've lost memory and some cognitive skills over the years, and my short term memory has gotten worse by the year. I have large gaps in my "early years", I mean huge black holes. Family will say "you remember...." and don't believe me when I tell them "no, I have no memories at all of those years".... that undiagnosed OSA very well the culprit. Hubby had a mind like a steel trap, I mean his memory, both long and short term were phenominal. Then he had his heart attack, and during that and his hours after the catheterizaion, he was desatting like crazy. We had to keep urging him to breathe....he has almost no short term memory now....and that started immediately after his heart attack. Lump that on top of his OSA that I know he has had for years, but could only recently get him to get tested (after I did)....I"m convinced.

[TSSleepy]

There is no doubt in my mind that I am not as sharp at 41 as I was at 21.

My longterm memory has always been pretty bad. I don't think I have ANY direct childhood memories, just those foggy ones that are written and rewritten into my brain by re-tellings at family gatherings and looking through photo albums.

I still hang out with my high school buddies, and they'll occasionally say, "Hey remember in high school when...!" At best, the events they bring up are vaguely familiar. If I think long enough, small hints of the event will appear. Like those pixellated posters, where you stare at them long enough with eyes unfocused and you can finally see a sail boat.

But I'd always been pretty good at remembering the "now" and various facts/figures. That really abandoned me the last few months, before I started CPAP. I'd take a pill, and 10 minutes later couldn't remember if I'd taken it or not. I'd sit in a meeting, and an hour later I'd know there was some action item I was responsible for, but couldn't for the life of me remember what. That's when I started getting scared!

Fortunately, that short-term memory deficit is easing off now that I'm getting treatment.

The only other neurological effect I've noticed is that I've become a "dyslexic typer". I have to proofread everything now a lot more closely than I did the first 30-something years of my life. I know exactly how to spell things, and easily spot the typos if I remember to proofread. But somewhere between my brain and my hands, two letters get transposed. I'm hoping that will back off a bit too now that I'm getting treatment!

The memory issue always reminds me of joke I heard:

A man runs into his parents at the mall. While his mother window shops, he talks with his dad.
Son: "So what have you two been up to today?"
Father: "We saw a movie here at the mall."
Son: "Oh yeah? What did you guys watch?"
Father: "Umm, let me think...hmm. It's on the tip of my tongue. Ummm. What's that romantic red flower called?"
Son: "A rose?"
Father: "That's it!" He turns to his wife and calls out, "Rose, what was the name of that movie we saw today?"

[Guest]

All very sad, very true and very frightening. Faithfully treating osa for years but still going 'down hill' and losing ground.

[MrSandman]

There is no doubt in my mind that I am not as sharp at 41 as I was at 21.

My longterm memory has always been pretty bad. I don't think I have ANY direct childhood memories, just those foggy ones that are written and rewritten into my brain by re-tellings at family gatherings and looking through photo albums.

I still hang out with my high school buddies, and they'll occasionally say, "Hey remember in high school when...!" At best, the events they bring up are vaguely familiar. If I think long enough, small hints of the event will appear. Like those pixellated posters, where you stare at them long enough with eyes unfocused and you can finally see a sail boat.

But I'd always been pretty good at remembering the "now" and various facts/figures. That really abandoned me the last few months, before I started CPAP. I'd take a pill, and 10 minutes later couldn't remember if I'd taken it or not. I'd sit in a meeting, and an hour later I'd know there was some action item I was responsible for, but couldn't for the life of me remember what. That's when I started getting scared!

Fortunately, that short-term memory deficit is easing off now that I'm getting treatment.

The only other neurological effect I've noticed is that I've become a "dyslexic typer". I have to proofread everything now a lot more closely than I did the first 30-something years of my life. I know exactly how to spell things, and easily spot the typos if I remember to proofread. But somewhere between my brain and my hands, two letters get transposed. I'm hoping that will back off a bit too now that I'm getting treatment!

The memory issue always reminds me of joke I heard:

A man runs into his parents at the mall. While his mother window shops, he talks with his dad.
Son: "So what have you two been up to today?"
Father: "We saw a movie here at the mall."
Son: "Oh yeah? What did you guys watch?"
Father: "Umm, let me think...hmm. It's on the tip of my tongue. Ummm. What's that romantic red flower called?"
Son: "A rose?"
Father: "That's it!" He turns to his wife and calls out, "Rose, what was the name of that movie we saw today?"

Did I write this post

[roster]

Does prolonged OSA contibute to Dementias ?

Absolutely not.

It causes it.

[pfann447]

My father died of complications of Parkinson's Disease in 2006. He also had CAD and had had a CABG in 1986 (which lasted him until his death). And yes, he had untreated OSA. He was diagnosed in 1990-something, tried CPAP but could not tolerate it, tried a dental appliance but could not tolerate it, and basically ignored it after that.

I am personally convinced that, had his OSA been properly treated, my father would be alive today.

Pfann

[Ms Piggy]

thanks for the article & seminar link.
This is my 4th year and I am feeling somewhat better, perhaps if I can get my therapy to a more efficient level it might help. I still have trouble thinking clearly at times and am told that I am forgetting things more. great!
I had undiagnosed OSA for something more than 10 yrs before I was diagnosed. Yesterday I found a list dated 1999 that my Dr. had me make out listing the mornings I awoke with a headache and what I had eaten the night before. I had complained about headaches for some years before this (useless) step was taken. IF ONLY our GP's knew something about the various symptoms it would make a big difference. I consider that my Dr. is a good one, but I just didn't fit the current "OSA model". It's time to throw out the old criteria and recognized that one does not have to be over weight, etc. to have OSA.
I do hope that other parts of the brain do take over, heaven help me if that has already happened in my case!

I had an MRI last year, I am hoping to go back to the specialist to ask him to look at it again with OSA in mind to see what, if anything, shows. Could be it's not the right type of MRI to show anything.

[OutaSync]

The only other neurological effect I've noticed is that I've become a "dyslexic typer". I have to proofread everything now a lot more closely than I did the first 30-something years of my life. I know exactly how to spell things, and easily spot the typos if I remember to proofread. But somewhere between my brain and my hands, two letters get transposed. I'm hoping that will back off a bit too now that I'm getting treatment!

WOW!! THat is what has happened to me, also. I can't type the way I used to. I put the spaces in the wrong places and get the letters in the wrong order. I, too, am a good speller, but something is going wrong between my brain and my fingers. I work in the legal field and it takes twice or three times as long to type documents as I have to go back and correct a myriad of things.

I read that whole book, "Deadly Sleep" this afternoon. What a fascinating book. The author went through incredible things to overcome his OSA. THat book should be a "must read" for everybody. The mere fact that I could read the book is a miracle for me. I have not been able to read a book for years. I could read an entire page and realize that I had no idea what I just read. After a year and a half on CPAP, I must be getting a little better. I really don't think I even started to get better until I switched to the SV. I may still wake up a dozen or more times a night, but at least I know that my brain is getting it's oxygen.

Bev

[TSSleepy]

WOW!! THat is what has happened to me, also.

Bev

THat is happening to me a lot too! I try to capitalize the first letter of a sentence or name, and end up capitalizing the first two letters!

And it's definitely more than just transpositions, because earlier today I tried to type "rebound" and ended up typing "roubound". Ummm, what???

It's been driving me crazy, because I never used to have this problem. There's obviously some brain wiring issues going on, and I really hope it's not permanent...

[roster]

......... There's obviously some brain wiring issues going on, and I really hope it's not permanent...

Good new/bad news.

First the bad news: The damage is permanent.
According to my sleep doc/neurologist, we have spiders (lesions) throughout the brain caused by repeated apneas over many years. I have confirmed this with references found on the internet. Also a recent UCLA study found the two mammillary bodies at the base of the brain stem in all patients are shrunken about 20%

Now the good news: there is a healing process if OSA is properly treated.
The damage may not be repaired but the brain can learn ways to compensate.

I have evidence in my own case, that after 11 months of good CPAP therapy my memory began to improve, my reasoning abilities started to return, and most importantly, my ability to handle stress began to improve.

So work on having a good CPAP therapy, have a good exercise regimen, and eat a healthy diet, low in carbs and high in protein and healthy fats. Take it as a challenge and in some months you will likely start to see improvement.

[dsm]

<snip>

I have evidence in my own case, that after 11 months of good CPAP therapy my memory began to improve, my reasoning abilities started to return, and most importantly, my ability to handle stress began to improve.

So work on having a good CPAP therapy, have a good exercise regimen, and eat a healthy diet, low in carbs and high in protein and healthy fats. Take it as a challenge and in some months you will likely start to see improvement.

Rooster

Amen amen - I too have found that continual CPAP therapy seems to greatly improve handling stress. You also mention exercise & that for me is also super important. When I get overweight, I don't believe I am as mentally sharp as when I am fit. I have joined CarbonMan in taking up cycling & if anything has helped it was that. I am now cycling t0 work approx 17 kms. Took me 2 goes to find a bike with the best gear ratios for our hilly area but am reaaly enjoying it.

This cpap therapy thing is as important to me as life as am sure mine will deteriorate if I were not right on top of it.

DSM